The present invention relates to a system that provides an integration of records of clinical laboratory services into the assessment and optimization of patient health care and, in particular, use of pharmaceuticals. The laboratory records are used in conjunction with other health care benefits records to monitor regulation of use of pharmaceuticals by patients.
Laboratory results provide quantitative and continuous measures of a patient's physical status. Optimal management of many diseases, especially those treated with pharmaceuticals, requires routine monitoring for blood levels of drugs or key disease indicators. The incorporation of laboratory results into a system to monitor regulation of drug use provides a better understanding of the relationship between medical services, prescribed drugs, and laboratory findings.
Current drug utilization review software uses the appearance and number of ICD9CM diagnosis codes reported on health care claims to assume illness and severity of illness. In using ICD9CM and drug data alone, disease management relies heavily on limited surrogate measures of disease progression and outcomes. The presence of health benefit claims records for drugs to treat diseases is also used as a proxy of illness. Using these two data elements (ICD9CM diagnosis codes and NDC drug codes), one commercially available software package, known as RationalMed™, applies rules to identify inappropriate drug therapy. These types of inappropriate drug therapy are categorized as drug-disease problems, drug-drug problems, drug utilization problems, over/under utilization of drugs, drug duration problems, and drug duplication problems. The presently available software system does not use or incorporate laboratory tests and their results into the drug monitoring function.
Laboratory result data support the monitoring of clinical outcomes (positive or negative) of important and sometimes costly drug therapies based on the longitudinal tracking of laboratory result indicators. Laboratory test results also enable the monitoring of blood levels of certain medications. By combining actual blood level results with over and under dosing criteria into drug utilization review software, frequent false positive findings that occur by using apparent daily dose alone may be minimized. And, as drug-drug interaction screening has proven to be an important clinical tool, similarly, inclusion of drug-laboratory interactions in drug utilization software would furnish treatment providers with information on potentially dangerous drug interactions that could lead to erroneous treatment decisions. Almost universally, the addition of laboratory test values to drug utilization software will provide sensitive continuous measures to support and validate assumptions drawn from the categorical data routinely available from medical claims data.